COVID-19 USA---Available Ventilators by State--CAMBRIDGE U PRESS, 2010

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IMMEDIATE REL//ATTN:CD@TCNT//MSGCMDCOC//&JC-EOC//URGENT

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     "...to see where the surplus can be appropriated for use in the hotspots..."

     (The Lab)--Published in 2010 and not available online until 2013, the survey includes not just the total numbers according to those who responded, but percentage in relation to 100,000 population per state. The top 5 states include California (6589), Texas (5419), New York (4506), Florida (4307), and Pennsylvania (3013). The data at the study was pasted into a spreadsheet, sorted by descending availability and graphed.

     The hotspot Louisiana is at #19 with 1109 ventilators in the state in this dated survey. Dated because there doesn't appear to be any more recent stats on individual numbers. However, the 2010 guideline can at least indicate the necessity for redistribution not just statewide, but federally as well.
     According to the study  published at Cambridge U., the survey was based on the following procedure;
     "Respondents were asked to report on the number and types of mechanical ventilators owned by their respective medical facilities in the following 10 categories, based on the framework of Rubinson et al1: full featured, high frequency, portable mechanical (pneumatic driven only), portable, basic emergency medical services transport, noninvasive, CPAP only, automatic resuscitators, neonatal-pediatric–specific and standby (no longer used for every day patient care but maintained and available on site). The survey instrument was updated to include all mechanical ventilators and automatic resuscitators approved by the US Food and Drug Administration up until the date of the initial survey mailing. Manual resuscitators were not included. Also, anesthesia machines were not included, because respiratory care professionals were unlikely to be able to provide accurate information regarding anesthesia machine model, quantities, and functional capabilities." (Rubinson et. al.)

      The next step is to compare the number of available ventilators by state to the outbreak to see where the surplus can be appropriated for use in the hotspots. This may alleviate some of the pressure on the federal government to commit its current stockpile in reserve to a place where a hotspot may appear only as a mirage. Not included in this survey may also have been  recent numbers as to inventory at manufacturers.

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Source
Rubinson, L., Vaughn, F., Nelson, S., Giordano, S., Kallstrom, T., Buckley, T., . . . Branson, R. (2010). Mechanical Ventilators in US Acute Care Hospitals. Disaster Medicine and Public Health Preparedness, 4(3), 199-206. doi:10.1001/dmp.2010.18
https://www.cambridge.org/core/services/aop-cambridge-core/content/view/F1FDBACA53531F2A150D6AD8E96F144D/S1935789300002731a.pdf/mechanical_ventilators_in_us_acute_care_hospitals.pdf

https://covidtracking.com/data/

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IMMEDIATE REL//ATTN:CD@TCNT//MSGCMDCOC//&JC-EOC//URGENT

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LAB009 & #COVID-19--Social Media Burnout--UNIV OF NEVADA, RENO, SPRING 2020

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JOUR107.1001//James L’Angelle//@eyelessoncampus//University of Nevada, Reno

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04 April 2020

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Lab 009: Social Media Burnout

(1) Follow professionals:

LIST: “COVID-19”
https://twitter.com/i/lists/1246151073456205830

Jennifer Jacobs, @JenniferJJacobs, senior White House reporter for Bloomberg News
Kristen Welker, @kwelkernbc, NBC News White House Correspondent.
George Stepanopoulos, @GStephanopolous, ABC Good Morning America anchor
Jonathon Karl, @jonkarl, ABC White House correspondent
Major Garrett, @MajorCBS, Washington correspondent, CBS News

Reviewing Jennifer Jacobs’ posts related to the White House news briefing today, she did seem a bit more concerned with some off-topic material surrounding the virus updates such as;
     “One for the history books. “I want to come way under the models. The professionals did the models. I was never involved in a model. But—at least this kind of a model,”  and;
     “Trump grew impatient as Birx talked about waiting til ‘we get through all this’ before we ask questions about what we could’ve done better as global community.”

Kristen Welker had no posts regarding the briefing today and retweeted a Soldedad O’Brien tweet on shelter-in-place while broadcasting. Her latest post was on the role of VP Pence leading the task force, linked to an NBC article.

George Stephanopoulos, ABC-GMA anchor is very weak on Twitter posting, having done so just four times in March and April.

Jonathon Karl was very vocal in the White House briefing today, with focus on questions as to why Jared Kushner referred to the Strategic National Stockpile (SNS) as “our stockpile,” a characterization that created a stir in the press corps. They mainly wondered what Kushner was doing there in the first place and Karl received less wrath from the President than others who directed the same question at him. In a late post this afternoon, Karl was on his game;
     “Asked if he could assure New York if ‘they're going to have the ventilators that they're going to need,’ Pres. Trump tells @jonkarl, ‘No, they should have had more ventilators at the time. ‘."
Karl knows which questions to ask and for that matter, wasn’t limited in the briefing today to just two questions, the President returned to him at least once. Late news coming out of New York is that the governor will literally confiscate unused ventilators from “upstate.” (French, Politico)

Within the hour (17:00 PDT) Major Garrett has retweeted a Tony Valentino, @tony561, post regarding Garrett’s podcast “Debriefing the Briefing,” reported by Joe Concha at The Hill as;
     “CBS News chief Washington correspondent Major Garrett has launched a new podcast, “Debriefing the Briefing," which will focus on the White House coronavirus task force briefings.” (Concha,The Hill)

Although at least one of the COVID-19 list appears weak on Twitter, Stephanopoulos is a critical part of the ABC news team and usually appears anchoring the daily White House briefings from the network’s New York studio.

Sources
French, Marie J., National Guard to seize ventilators, https://www.politico.com/states/new-york/albany/story/2020/04/03/cuomo-plans-to-use-national-guard-to-seize-ventilators-from-upstate-facilities-1271376
Concha, J., Garrett launches new coronavirus podcast https://thehill.com/homenews/media/491086-cbs-news-correspondent-major-garrett-launches-new-coronavirus-podcast

(2) Identify the people, hashtags and search terms relevant to the story
     It is safe to say the entire world has comments about the virus pandemic sweeping the globe. It is difficult to separate the wheat from the chaff as someone in authority or considered “reputable” may give misleading information that creates so much controversy in the news that reporters have trouble staying on topic. One has to read through hundreds of news stories and social media posts to gain insight as to the status of the subject. In addition, the Twitter hashtags change rapidly, some trend so fast that a great deal of valuable information drops off the radar faster than it can be picked up. The usefulness of social media becomes questionable as reliable with these kinds of limiting parameters.

     News search sources, Google in particular, offer stories that can fall behind significantly where “yesterday” is already last year’s news. A good example is from above, while the ABC correspondent Jonathan Karl fielded questions today at the White House briefing on the New York’s governor’s request for ventilators, the governor had issued an order that the National Guard go “upstate” and literally confiscate unused ventilators from hospitals not seriously impacted by the surge.
     Twitter, still, is the go-to source at least for an abbreviated “lead” on what’s trending and hopefully, it will point in a direction that was overlooked.
Hashtags: Trending related to the virus include #COVID19, #COVID19Pandemic, and similar ones that include at least the first few characters, when typed in, will give the related string of currently trending hashtags.
     Even then, it is better to ferret out the stories individually, such as the recent one regarding the outbreak of the virus on the USS Theodore Roosevelt, currently anchored and quarantined in Guam. So many of the reports coming out were Associated Press duplicates, triplicates and beyond, it almost seemed like reading censored propaganda. To get to the root of the story, it proved valuable to search Google for “Guam newspapers.” There it was discovered through the local press locations of the quarantined hotels, rules in place for the sailors where the local beaches were off limits and the means used to transport them away from the ship. (Pan Pacific Press)

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Sources
#COVID-19 GUAM--The USS Roosevelt Evac--SCUTTLEBUTT, https://panpacificpress.blogspot.com/2020/04/covid-19-guam-uss-roosevelt-evac.html
Image of sailor-transport, https://www.postguam.com/news/local/covid-19-cases-climb-to-82/article_163f0004-74d7-11ea-a98a-afd68ef77887.html
https://www.postguam.com/news/local/covid-19-cases-climb-to-82/article_163f0004-74d7-11ea-a98a-afd68ef77887.html

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JOUR107.1001//James L’Angelle//@eyelessoncampus//University of Nevada, Reno

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COVID19 CALIFORNIA-- Hospital Turnaround Potential--SURGE VS MITIGATION

#COVID19 CALIFORNIA-- Hospital Turnaround Potential--SURGE VS MITIGATION

IMMEDIATREL//@CD/TCNT/CMDMSGCTR//COC/JC-HRED//URGENT "...two variables that will inevitably determine whether the virus can be contained at its marginal level..." (The Blvd)--The following statistics are useful in determination of the Golden State potential to fight the virus regionally with respect to availability of hospitals with the necessary gear on board for patient turnaround.

COVID19 VENTILATORS--California: Faulty Units Stored-Shipped --- LTV-1200 MAINTENANCE SNAFU

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IMMEDIATEREL//CCATTN/CD@TCNT//CMDCOCMSCCTR//JC-EOC//URGENT

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     "...a week ago none of us knew anything about ventilators..."

     (The Lab)--- Governor Newsom of California ordered a recent shipment of flawed ventilators to be refurbished at a converted fuel-cell plant in Sunnyvale.  (ABC) The model number as seen from screengrabs by news agencies is the LTV-1200.  At the California respiratory Care Board's website, the following information regarding a similar, if not the same, device can be found;
     "In 2007, the State of California purchased and stockpiled 2,400 "Cardinal Health LTV 1200" ventilators for the purposes of disaster or emergency response." (RCB/CA)
Apparently, many of those devices never left the boxes and the batteries are dead;

     "Newsom said California currently has a little over 4,200 ventilators, but more than a thousand of them don’t work. ..The state of California also needs its own stockpile of ventilators fixed – Newsom said 514 ventilators had not been unboxed since 2011 and their batteries no longer work." (KTVU)

     "At the beginning of the pandemic, California had about 7,500 ventilators across the state’s hospital systems and aimed to get another 10,000 ventilators, according to the press release." (Time)

     "More than 500 of these ventilators are from the state Department of Public Health, according to Newsom, and they hadn’t been out of the box since 2011. Even the batteries didn’t work, the governor said. " (CAPradio)

     Not only did the units sent to the state from the Strategic National Stockpile not work, the ones stored locally appeared to have also not been properly maintained. It is no wonder the governor doesn't want to engage in "finger-pointing" as the state is equally guilty of neglect over maintenance.

     Chapter 5 of the Cardinal Health service manual for model LTV-1200 offers strict guidelines on the proper maintenance of the unit;
     "While in storage, every two months -- Recharge the internal battery by plugging the ventilator into an AC power source for 24 hours" (Page 5-1)
In addition, the maintenance procedure also calls for replacement of the battery after a given period. Other requirements demand servicing done by a trained technician certified by Pulmonetic Systems, Inc.  What did the Bloom Energy CEO have to say about his technicians' qualifications for servicing the LTV-1200s?
     " 'Hopefully, what we're doing here is to say, we can do this, a week ago none of us knew anything about ventilators other than what they're used for,' said Bloom CEO K.R. Sridhar." (ABC)


Sources
RCB/CA, https://www.rcb.ca.gov/licensees/disaster_response.shtml
Bloom Energy,
https://abc7news.com/society/silicon-valley-energy-company-refurbishes-ventilators-for-ca-during-covid-19-crisis/6059357/
Don't Work,
https://www.ktvu.com/news/gov-newsom-mayor-liccardo-tour-sunnyvale-company-refurbishing-ventilators
Total #, https://time.com/5812147/california-coronavirus-broken-ventilators/
Dead Batteries, http://www.capradio.org/articles/2020/03/28/california-wants-10000-more-ventilators-for-hospitals-its-almost-halfway-and-companies-are-reinventing-themselves-to-help/
LTV-1200 Training Video,  https://www.youtube.com/watch?v=JEjjLNzOKQ0
Cardinal Health LTV 1200 Service Manual, http://www.usmed-equip.com/content/datesheet/pdfs/Pulmonetic%20LTV%201200-1150%20Service%20Manual%20Rev%20E.pdf
Cardinal Health, https://www.indemed.com/Catalog/searchresults.cfm?keyword=ltv+1200&source=header

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IMMEDIATEREL//CCATTN/CD@TCNT//CMDCOCMSCCTR//JC-EOC//URGENT

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COVID19 HOARDING--Defense Production Act, Sect. 2072--FEDERAL REGISTER LIST--03/30/2020

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IMMEDIAEREL//ATTN:CD@TCNT//VIACMDMSGCTR//EOC//JCL//URGENT

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     "...opening the door for speculators and profiteers to bypass restrictions on cornering the market..."

     (The Scullery)--  Section 2072 of the Defense Production Act (DPA) of 1950 represents "Hoarding of designated scarce materials," with the following paragraph;
     "...no person shall accumulate (1) in excess of the reasonable demands of business, personal, or home consumption, or (2) for the purpose of resale at prices in excess of prevailing market prices, materials which have been designated by the President as scarce materials or materials the supply of which would be threatened by such accumulation. The President shall order published in the Federal Register, and in such other manner as he may deem appropriate, every designation of materials the accumulation of which is unlawful and any withdrawal of such designation."
That list related to the COVID-19 Emergency can be found at the Federal Register and is dated tomorrow, 20 March 2020:

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     The DPA calls for a penalty of not more than $10,000 or one year in prison, or both; which seems rather inadequate when considering what profiteers might stand to gain by stockpiling some of the critical items like surgical masks. Number 15 appears to be just one of those critical and scarce items;
     "Ventilators, anesthesia gas machines modified for use as ventilators, and positive pressure breathing devices modified for use as ventilators (collectively referred to as ‘‘ventilators’’), ventilator tubing connectors, and ventilator accessories." (FedReg)
     The link at the Federal Register, https://www.fda.gov/ media/136318/download, related to FDA Enforcement Policy for Ventilators returns "Page Not Found." Without access to FDA definitions, to what degree the ventilators and their accessories come under the DPA and FDA mandates remains unclear, thus opening the door for speculators and profiteers to bypass restrictions on cornering the market.

     Most, if not all, of the items listed at the Register are in direct relation to medical supplies and seem to overlook consumer based items such as bathroom paper products which have been in critical short supply since the onset of the pandemic crisis. To what degree the federal government through the DPA has authority over determination if the paper products fall under the hoarding category is unclear. Some of the restrictions are listed below Section 2072 but do not clarify a position on consumer products. There may be stipulations on price controls that would curtail scalping by hoarders.

Sources
Hoarding, DPA, Sect 2072, https://www.govinfo.gov/content/pkg/USCODE-2014-title50/html/USCODE-2014-title50-app-defensepr.htm
FedReg Hoarding Bulletin, https://www.govinfo.gov/content/pkg/FR-2020-03-30/pdf/2020-06641.pdf
Factory Image, Hamilton Medical Mfgr.

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IMMEDIAEREL//ATTN:CD@TCNT//VIACMDMSGCTR//EOC//JCL//URGENT

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COVID19 USN-- Off-Limits @ Yokosuka Base--FACEBOOK SCUTTLEBUTT (MUTINY?)

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IMMEDIATEREL//FMNAVCOMCINPAC//ATTN:CD@TACNET//VESSELINFO//CLSFD

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     "...Whether or not contamination of the carrier is evident has not been addressed …"

     (The Scullery)--With the USS Theodore Roosevelt out of action and moored at Navy Base Guam, yet another American aircraft carrier has now reported cases of the deadly virus onboard, the USS Ronald Reagan;

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Now Both Aircraft Carriers In The Western Pacific Have COVID-19 Cases, Raising Readiness Concerns

Two sailors onboard the Nimitz class aircraft carrier USS Ronald Reagan, which forward-deployed in Japan and presently pier-side there, have tested positive for the COVID-19 novel coronavirus. This comes just a day after the U.S.

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     "Fleet Activities Yokosuka, a U.S. Navy base in the city of the same name, where the carrier is presently moored, will reportedly be on lockdown at least through the weekend. It's not clear yet what other steps the service may take, such as quarantining the entire ship." (The Drive)
According to the Marine Traffic website, which plots locations of ships, the USS Reagan had sailed recently from Singapore and was shown at Marine Traffic to be in the Yokosuka harbor in November, (image to left). None of the news articles currently indicate when the carrier arrived recently or whether it has been in the harbor for some time.  The website for the US Naval Institute shows a map in an article dated 02 March with the USS Reagan in port in Yokosuka, three weeks before the recent postings related to infected sailors onboard. (USNI) A Stars & Stripes article dated 24 August 2019 reported that the USS Reagan had just returned to port having been at sea for three months. The Caitlin Doornbos article notes the carrier's itinerary during that mission at sea;
     "The Reagan made two stops over its 94-day deployment. First at Brisbane, Australia, to join in the Talisman Sabre 2019 war games off Australia’s east coast, then at Manila, Philippines for a brief port visit. The Reagan also participated in several exercises at sea with partner nations, most recently with the Japan Maritime Self-Defense Force." (S&S)
Considering the span of the recent time out at sea, it is not beyond speculation that the Reagan has been in harbor since November, meaning that the sailors may have contracted the virus on shore. Again, Doornbos reports yesterday of the status quo of the infected sailors, and it appears that the disease may well have been contracted onshore;
          " 'With the unknown origins of these new cases, we need to take some immediate conservative actions to protect the health of our community until the nature of the public health threat can be characterized,' Yokosuka commander Capt. Rich Jarrett said in the statement.” (S&S2)
Whether or not contamination of the carrier is evident has not been addressed in the recent article concerning the outbreak.

     Clearly, the base commander is unaware of the nature of the origin according to his quote. In her Navy Times story dated "3 days ago," Diana Stancy  Correll reports the first sailor to have been found infected had actually recently returned to the base from the United States;
     "...the sailor returned to Japan from the U.S. on March 15 and was subsequently placed under Restriction of Movement status for 14 days — meaning the sailor was not permitted to interact with individuals outside of his or her assigned quarters." (Sailor-Zero)
The story does not reveal where the sailor was in the USA. The Navy base Facebook page shows a shelter-in-place order for the installation. From the tone of the posts at the Facebook page, many do not like the idea at all, especially the orders to stay inside. One sailor complains that housing services aren't open and he will be stuck on a ship.
     Others comment that the total number of infected personnel at the base may be as high as five, as reported by a Japanese TV station where the stories are untranslated. Sailors are being restricted to ship. When inquiring about the total number of cases, the sailors are being sent to the generic Navy.mil website or told that numbers are not available due to security and operational readiness.  Only "mission-essential personnel" are ordered to report to work.

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Commander Fleet Activities Yokosuka

Commander Fleet Activities Yokosuka, Yokosuka-shi, Kanagawa, Japan. 52K likes. http://www.cnic.navy.mil/regions/cnrj/installations/cfa_yokosuka.html http://www.youtube.com/cfayyokosuka...

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USS Reagan Page, https://www.reagan.navy.mil/
Marine Traffic, Yokosuka, https://www.marinetraffic.com/en/ais/home/shipid:4961183/zoom:15
Navy Base Yokosuka, https://www.thedrive.com/the-war-zone/32772/now-both-aircraft-carriers-in-the-western-pacific-have-covid-19-cases-raising-readiness-concerns
Carrier Locations, https://news.usni.org/2020/03/09/usni-news-fleet-and-marine-tracker-march-9-2020
Reagan at Sea, https://www.stripes.com/news/us/uss-ronald-reagan-returns-to-japan-after-three-months-at-sea-1.595647
Onshore, https://www.stripes.com/news/pacific/two-more-yokosuka-based-sailors-test-positive-for-coronavirus-commander-orders-base-to-shelter-in-place-1.623910
Sailor-Zero, https://www.navytimes.com/news/coronavirus/2020/03/26/first-service-member-in-japan-tests-positive-for-covid-19-after-returning-from-us/
Yokosuka Facebook, https://www.facebook.com/pg/cfayokosuka/posts/

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IMMEDIATEREL//FMNAVCOMCINPAC//ATTN:CD@TACNET//VESSELINFO//CLSFD

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